Apraxia 

of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person
has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or
paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of
speech can range from mild to severe.
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What are the types and causes of apraxia?

There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of
speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in
adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the
loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury,
tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle
weakness affecting speech production (dysarthria) or language difficulties caused by damage to the
nervous system (aphasia).
Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to
affect more boys than girls. This speech disorder goes by several other names, including
developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood
apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a
child follows the “typical” path of speech development but does so more slowly than normal.

The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related
to a child’s overall language development. Others believe it is a neurological disorder that affects the
brain’s ability to send the proper signals to move the muscles involved in speech. However, brain
imaging and other studies have not found evidence of specific brain lesions or differences in brain
structure in children with DAS. Children with DAS often have family members who have a history of
communication disorders or learning disabilities. This observation and recent research findings suggest
that genetic factors may play a role in the disorder.

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What are the symptoms?

People with either form of apraxia of speech may have a number of different speech characteristics, or
symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the
correct order to form words. Longer or more complex words are usually harder to say than shorter or
simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking.
For example, they may say a difficult word correctly but then have trouble repeating it, or they may
be able to say a particular sound one day and have trouble with the same sound the next day. People
with apraxia of speech often appear to be groping for the right sound or word, and may try saying a
word several times before they say it correctly. Another common characteristic of apraxia of speech is
the incorrect use of “prosody” — that is, the varying rhythms, stresses, and inflections of speech that
are used to help express meaning.

Children with developmental apraxia of speech generally can understand language much better than
they are able to use language to express themselves. Some children with the disorder may also have
other problems. These can include other speech problems, such as dysarthria; language problems
such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information;
problems with reading, writing, spelling, or math; coordination or “motor-skill” problems; and chewing
and swallowing difficulties.

The severity of both acquired and developmental apraxia of speech varies from person to person.
Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional
problems pronouncing words with many syllables. In the most severe cases, a person may not be able
to communicate effectively with speech, and may need the help of alternative or additional
communication methods.

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How is it diagnosed?
Professionals known as speech-language pathologists play a key role in diagnosing and treating
apraxia of speech. There is no single factor or test that can be used to diagnose apraxia. In addition,
speech-language experts do not agree about which specific symptoms are part of developmental
apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a
group of symptoms, including those described above. Ruling out other contributing factors, such as
muscle weakness or language-comprehension problems, can also help with the diagnosis.
To diagnose developmental apraxia of speech, parents and professionals may need to observe a
child’s speech over a period of time. In formal testing for both acquired and developmental apraxia,
the speech-language pathologist may ask the person to perform speech tasks such as repeating a
particular word several times or repeating a list of words of increasing length (for
example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may
also examine a person’s ability to converse, read, write, and perform non-speech movements. Brain-
imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish
acquired apraxia of speech from other communication disorders in people who have experienced brain
damage.

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How is it treated?
In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on
their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not
outgrow the problem on their own. Speech-language therapy is often helpful for these children and for
people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single
approach has been proven to be the most effective. Therapy is tailored to the individual and is
designed to treat other speech or language problems that may occur together with apraxia. Each
person responds differently to therapy, and some people will make more progress than others. People
with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and
encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways
to express themselves. These might include formal or informal sign language, a language notebook
with pictures or written words that the person can show to other people, or an electronic
communication device such as a portable computer that writes and produces speech.

A.)  Stuttering is a problem that interferes with fluent speech. A person who stutters may repeat
the first part of a word (as in wa-wa-wa-water) or hold a single sound for a long time (as in
caaaaaaake). Some people who stutter have trouble getting sounds out altogether. Stuttering is
complex, and it can affect speech in many different ways.
Treatment

 Fluency shaping therapy, also known as "speak more fluently", "prolonged speech"   or
"connected speech", trains stutterers to speak fluently by controlling their breathing, phonation,
and articulation (lips, jaw, and tongue). It is based on operant conditioning techniques.

Stutterers are trained to reduce their speaking rate by stretching vowels and consonants, and
using other fluency techniques such as continuous airflow and soft speech contacts.

Anti-stuttering medications

The effectiveness of pharmacological agents, such as benzodiazepines, anti-convulsants, anti-

depressants, antipsychotic and antihypertensivemedications, and dopamine antagonists in the
treatment of stuttering has been evaluated in studies involving both adults and children

Diaphragmatic breathing

Several treatment initiatives advocate diaphragmatic breathing (or costal breathing) as a means

by which stuttering can be controlled.

Cluttering (also called tachyphemia) is a speech disorder and a communication

disorder characterized by speech that is difficult for listeners to understand due to rapid speaking
rate, erratic rhythm, poor syntax or grammar, and words or groups of words unrelated to the
sentence. Cluttering has in the past been viewed as a fluency disorder.

Treatment

Speech and Language therapy

B.) Dysprosody
 
Dysprosody, sometimes also called psuedo-foreign dialect, is a speech disorder characterised by
alterations in the intensity, timing and rhythm, cadence and/or intonation of words. In layman’s
terms it means that an individual’s accent, or the way in which they pronounce and speak words,
is altered as may be their patterns of speech.
 
Treatments:
1.)   L-DOPA (L-3,4-dihydroxyphenylalanine) well as electrophysiological
treatments.
 
C.)  Muteness or mutism is a kind of speech disorder that causes an inability to speak. The term
mute originates from the latin word mutus, for silent.
Treatment with medications
In some cases, selective mutism is treatable with medication. Fluoxetine (Prozac), which is one
of the selective serotonin reuptake inhibitors (SSRIs) is the drug that has been studied most often
as a treatment for selective mutism. Treatment with medication is more successful in younger
children. Overall, fluoxetine has been found to reduce the symptoms of selective mutism in about
three-fourths of children. Other drugs used to treat anxiety and social phobia disorders may also
be effective in certain cases.

D.) Speech sound disorders are speech disorders in which some speech sounds

(called phonemes) in a child's (or, sometimes, an adult's) native language are either not produced,
not produced correctly, or are not used correctly.

E.) Aphasia is condition characterized by either partial or total loss of the ability to communicate
verbally or using written words. A person with aphasia may have difficulty speaking, reading,
writing, recognizing the names of objects, or understanding what other people have said. Aphasia
is caused by a brain injury, as may occur during a traumatic accident or when the brain is
deprived of oxygen during a stroke. It may also be caused by a brain tumor, a disease such as
Alzheimer's, or an infection, like encephalitis. Aphasia may be temporary or permanent. Aphasia
does not include speech impediments caused by loss of muscle control.

Treatment:

Medical treatment of aphasia is considered experimental; dopaminergic, cholinergic, and

stimulant drugs have been tried, but no clear benefit has been shown in large trials. In primary
progressive aphasia, the drugs used for Alzheimer disease have not been proven beneficial (and a
cholinergic deficiency is not evident as in Alzheimer disease). SSRI antidepressants have been
shown to help the emotional and behavioral problems.

F.) Articulation disorders encompass a wide range of errors people can make when talking.
Substituting a "w" for an "r" ("wabbit" for "rabbit"), omitting sounds ("cool" for "school"), or
adding sounds to words ("pinanio" for "piano") are examples of articulation
errors. Lisping refers to specific substitution involving the letters "s" and "z." A person who lisps
replaces those sounds with "th."

Treatment: Surgery
Medical Surgical Nursing Management

 Assist the patient in seeking an evaluation of his or her home and work
settings. Anticipate patient needs and pay attention to nonverbal cues.    Place important
objects within reach.  Provide alternate means of communication for times when
interpreters are not  available.

 Encourage patient’s attempts to communicate; praise attempts and achievements.

 Listen attentively when patient attempts to communicate. Clarify your understanding of

the patient’s communication with the patient or an interpreter.

 Never talk in front of patient as though he or she comprehends nothing.            

  Keep distractions such as television and radio at a minimum when talking to

patient.        

    Do not speak loudly unless patient is hearing-impaired.                                    

 Maintain eye contact with patient when speaking. Stand close, within patient’s line of
vision (generally midline).                                                 

 Give the patient ample time to respond                                                                     

 Praise patient’s accomplishments. Acknowledge his or her frustrations.

 If the patient’s ability to speak is limited to yes and no answers, try to phrase questions so
that the patient can use these responses.  

  Use short sentences and ask only one question at a time.              

 Speak slowly and distinctly, repeating key words to prevent confusion. Supplement
verbal communication with meaningful gestures.    

 Give concrete directions that the patient is physically capable of doing (e.g., "point to the
pain," "open your mouth," and "turn your head").

 Avoid finishing sentences for the patient. Allow the patient to complete his or her
sentence and thought; but if the patient appears to be having difficulty, ask the patient for
permission to help them. Say the word or phrase slowly and distinctly if help is
requested. Be calm and accepting during attempts; do not say you understand if you do
not.

 When patient has difficulty with verbal expressions, support the work the patient is doing
in speech therapy by providing practice sessions often throughout the day. Begin with
simple words (e.g., "yes," "no," "this is a cup"), then progress.
  When patient cannot identify objects by name, give practice in receiving word images

 Provide a list of words patient can say; add new words to it. Share this list with family,
significant others, and other care providers.  Provide patient with word-and-phrase cards,
writing pad and pencil, or picture board.                                               

 Carry on one-way conversation with a totally aphasic patient

 Consult a speech therapist for additional help. See that patient is well-rested before each
session with the speech therapist                                                                          

 Consider use of electronic speech generator in postlaryngectomy

patients.                                                                        

Education/Continuity of Care

 Inform patient, significant other, or caregiver of the type of aphasia the patient has and
how it affects speech, language skills, and understanding.

 Offer significant others the opportunity to ask questions about patient’s communication
problem.       

 Provide answers and helpful suggestions for what is known while not providing false
assurances.

 Encourage family member/caregiver to talk to patient even though patient may not
respond.                                                                                                                              

 Encourage patient to socialize with family and friends.             

 Explain that brain injury decreases attention span.

 Suggest that the family engage the patient often throughout the day for short periods.
Encourage the family to look for cues that the patient is over stimulated or fatigued.

 Provide patient with an appointment with a speech therapist, if not already done.

 Deaf patients and their families should be referred to their local hearing society for
community support, education, and sign language training.